保乳术后腋窝淋巴结标准切线野与多野放疗的剂量学比较

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1、万方数据保乳术后腋窝淋巴结标准切线野与多野放疗的剂量学比较彭冉王淑莲任雯廷王维虎房辉宋永文张可刘跃平苗俊杰李晔雄【摘要】目的评价标准切线野对腋窝I、Ⅱ站淋巴结覆盖情况，分析调强计划处方剂量给予腋窝淋巴结时正常组织剂量。方法回顾性分析15例左侧乳腺癌接受保乳手术、前哨淋巴结活检和全乳放疗。放疗计划以标准切线野为基础采用逆向调强方法优化。按照RTOG标准勾画I、Ⅱ站腋窝淋巴结，以原始计划计算I、Ⅱ站腋窝淋巴结靶区覆盖程度。每个患者设计全乳腋窝IMRT计划，CTV包括全乳和I、Ⅱ站腋窝淋巴结。处方剂量均为50Gy分25次。计算靶区HI和cI

2、及OAR的参数。结果标准切线野计划中I、Ⅱ站腋窝淋巴结D一分别为34．4,21．9Gy。腋窝I站V。V。分别为22．6％．49．9％，Ⅱ站分别为6．O％、22．0％。全乳腋窝调强计划降低了全乳照射剂量均匀性，PIV适形性也较差，并明显增加了同侧肺和心脏剂量，同侧肺V∞由17．1％增至34．2％，D。。。由999cGy增至I732cC,y。结论标准切线野不能很好覆盖I、Ⅱ站腋窝淋巴结。需要腋窝放疗者应行IMRT计划以保证腋窝接受足够剂量，但正常组织剂量明显增加。【关键词】乳腺肿，茸／外科学；腋窝淋巴结／放射疗法；剂量学Standardw

3、holebreasttangentialfieldsprovidesuboptimal嬲帅coverageandwholea,xiuaradiation嗣掣词艮捌删眵佃哪徽lugdoseinChinesebreastcsii傥rpatientstreatedwithbreastcon畿gvalivesurgeryandsentinelnodebiopsyPe增Ran，WangShulian，RenWenting，Wang耽访u，Fang胍，SongYongwen，ZhangKe，Liu州甲孵，Miao坤，Liyexiong．Depar

4、tmentofRadiationOncdogy，CancerHospital，ChineseAcademyofMedicalSciences，PekingUnionMedicalCollege，Be讲ng100021，ChinaCorrespondingtIHghOI'$．LiYexiong，Email：yexiongl2@J卯．corD,；WangShulian，Email：wsl20040118@yahoo．com【AbstrmlObjectivenlisstudyaimedtoevaluatethecoverageoftheLe

5、velIandIIaxillawithstandardwholebreasttangentialfields(聊’)．andtowhatextentthatwholeaxillaradiationcouldincreasethedosetonormaltissuewithdosimetricstudy．MethodsFifteenconsecutiveleftbreastcancerpatientstreatedwithbreastcoIiservallvesurgeryandsentinelnodebiopsyfollowedbyw

6、holebreastradiationwerestudied．Allhadinverse珊RTplanusingWFITwithprescriptiondoseof50Gvto95％oftheplanningtargetvolume(PrV)，definedasthewholebreast．LevelIandIIaxiUaWascontouredaccordingtotheRToGatlas．1rI圮dosedistributionandcoverageofLevelIandIIaxillawithWBTFwascalculated．

7、Newplansdelivering50Gyto95％ofthewholebreast船wellaSLevelIandIIaxilla(WB+AX)weredesigned．‰homogeneityindex(HI=D5／Dz)ofthewholebreastandconformalindex(CI=Vm／Tv，TV=targetvolume，Ⅷ=VolumeoftheReferenceIsodose)ofthetwoplan，thedosetotheheart，lung，leftanteriordescendingcoronarya

8、rtery(LAD)andcontralateralbreastwerecomparedbetweenWBTFandWB+AX．Results’IbevolumeofLevelsIandIIaxillaWas71．7an